A woman is completely dilated and at +2 station. Her contractions are strong and last 50-70 seconds. Based on this information, the nurse should know that the client is in which stage of labor?

1. A

   First stage

2. B

   Second stage

3. C

   Third stage

4. D

   Fourth stage

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

• The second stage of labor begins with full cervical dilation (10 cm) and ends with the birth of the baby.
• The client is described as 'completely dilated,' which is the defining characteristic for entry into the second stage.
• A fetal station of +2 indicates the presenting part is 2 cm below the ischial spines, signifying active descent through the birth canal, which occurs during the second stage.
• Strong contractions lasting 50-70 seconds are expected during this 'pushing' stage to facilitate the expulsion of the fetus.

Why Other Options Were Wrong

• Option A: The first stage of labor involves the onset of labor until the cervix is fully dilated. Since the client is already completely dilated, she has passed the first stage.
• Option C: The third stage of labor begins after the baby is born and ends with the delivery of the placenta. The scenario describes events happening before the baby's birth.
• Option D: The fourth stage of labor is the immediate 1-2 hour postpartum recovery period after the placenta has been delivered. The client has not yet delivered the baby or the placenta.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Identification of the stages of labor based on clinical signs to guide bedside assessment, documentation, and the next nursing action.
• Recognizing the second stage of labor is critical for the nurse to prepare for imminent delivery, implement appropriate pushing techniques, and monitor both mother and fetus for signs of distress.
• Nursing care during the second stage focuses on encouraging effective pushing, managing pain, ensuring fetal well-being through frequent heart rate monitoring, and preparing the environment for a safe birth.
• What if the client was 8 cm dilated and feeling an urge to push? The nurse should recognize she is in the transition phase of the first stage. The priority would be to manage the urge to push (e.g., with breathing techniques) until full dilation is confirmed to prevent cervical edema or tearing.

How to Approach the Question

• First, identify the key clinical findings provided in the question: 'completely dilated,' '+2 station,' and 'strong contractions.'
• Recall the definitions of the four stages of labor.
• Match the key finding 'completely dilated' to its corresponding stage. Full dilation (10 cm) is the landmark that signifies the end of the first stage and the beginning of the second stage.
• Use the other findings ('+2 station' and 'strong contractions') to confirm the assessment. These are consistent with the active pushing phase of the second stage.
• Eliminate the other stages based on their definitions: First stage (onset to full dilation), Third stage (birth of baby to placental delivery), and Fourth stage (post-placental recovery).

Concept Tested & Keywords

• Concept Tested: Identification of the stages of labor based on clinical signs.
• Stem keywords: completely dilated, +2 station, strong contractions, stage of labor
• Lead-in keywords: which stage
• Clinical cues: Complete dilation (10 cm) is the primary indicator for the start of the second stage of labor.
• Clinical cues: A +2 station signifies that the fetal head has descended significantly into the pelvic canal, past the ischial spines.

Question ID

QRFeFbqbZtXNdIxJW4PzEA

Copy ID

Reference Book

E6 Obstetrics Williams p. 22-41

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 40-48